caregivers meet with marginalized people suffering from psychological disorders

This article is part of our “Les focuses de franceinfo” operation, which highlights key topics that are little covered in the presidential campaign: the cost of housing, the public hospital crisis, the taboo of mental health and the carbon footprint of transport.

“I’ve been sleeping in the RER for fifteen days”, loose Basile *, 29 years old. He keeps his sleeping bag and his belongings contained in a single piece of luggage close at hand. Former student in the faculty of musicology, he worked in a large sign when he resigned, in 2018, “without thinking”after having “take the lead” with the manager. From there, the galleys are chained: loss of his accommodation, breakup, his friends who move away…

“It goes quickly”, he says. He lived six months in an artists’ squat in Seine-Saint-Denis, before resolving to sleep in the metro. In the early morning of March 18, the marauding Samu social team offered to follow her to their integration solidarity space, in the former Saint-Michel hospice, in the 12th arrondissement of Paris. She also invites him to participate, the same afternoon, in the Radio Mobile Paris program “La Maison dans le jardin”.

>> Presidential 2022: why franceinfo focuses on the taboo of mental health

Two musicians and two nurses from the precarious psychiatry mobile teams (EMPP) of the Paris University Hospital Group created this art therapy workshop. “Speech is given to those who cannot be heardunderlines Agathe Lebon, one of the two nurses present that day. This allows us to identify people who need psychiatric or psychological follow-up.”

A third of Ile-de-France residents without personal accommodation “suffers from severe psychiatric disorders, i.e. psychotic disorders, mood disorders (mainly severe depressive disorders) and anxiety disorders“reveals the latest Samenta survey of the Inational institute of health and medical research on the subject, published in 2010. Another study, conducted in France and published in 2019 in the journal Progress in Neuropsychoparmacology & Biological Psychiatry (study in English)observes that nine out of ten homeless people suffering from a serious psychiatric problem do not receive adequate treatment.

For these people, far from the healthcare system, only operations aimed directly at them, carried out by the EMPP, allow treatment. Created in the 1990s, the EMPPs were made permanent in 2005 by a decree. Nearly 110 teams of this type existed in France in 2011, “composed of more than 200 professionals, mainly nurses, psychiatrists and psychologists and, to a lesser extent, social workers”according to the Ministry of Health.

Seated among the fifteen people present for this fourth program of the year, Basile is the youngest participant. Under the big white tent, the first notes of the credits resonate. Jean*, a regular at the place, launches the program before passing the microphone to his neighbor for an introductory tour. Basil is “happy”. Her eyes sparkle at the sight of the piano.

“As soon as I find a piano, in stations or elsewhere, I play, it helps me keep my spirits up.”

Basile, homeless, 29 years old

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Although there is no imposed theme, very quickly the topicality of the war in Ukraine imposes itself in the exchanges. This “clear porosity between the events and the public of the EMPP” is not surprising François Lair, head of the Paris Nord-Est mobile team. “What is happening in Ukraine is one of the things they bring to the consultation and such events weaken the most vulnerable, who do not have the resources to deal with it.”

Corinne Friscaux, the mobile team’s psychiatric nurse, meets Basile for the first time. She feels it “full of emotions”, brittle. “I grew up in the middle of family problems, it was very dark between my parents”, says the young man. Placed in a foster family from the age of 8, he says he still has ties with his father and his two older sisters. “But for them, it’s: ‘Make it easy'”, he lets go.

the “core of precariousness is created in childhood”, notes François Lair. The journeys of the people he treats are made”of rejections, abandonments and placements”, lists the psychiatrist. “We recover a lot of people who were unhappy children, children who were not cared for and who, as adults, have problems”he points out.

“Mental suffering and precariousness are two notions that are eminently synergistic. Like a vicious circle, precariousness can reveal mental health problems, which themselves generate precariousness.”

François Lair, psychiatrist

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The Paris Nord-Est mobile team monitors approximately 450 people throughout the year. She faces various disorders: schizophrenia, anxiety-depressive disorders, psychotrauma, intellectual disability, narcissistic deficiencies or addiction problems.

If Basile easily followed the Samu social team, not everyone accepts this outstretched hand. “With the educators, we try to establish a relationship that does not scare the person away. They can quickly feel persecuted by poorly perceived helpdescribes Antoine Courtecuisse, the team’s second psychiatrist. The Samu social helps to suggest a meeting with us.”

“Sometimes we avoid saying that we are psychiatrists. We say that we are a care or health team, and we avoid using the arsenal of drugs too quickly, being in a position that is too medical, too psychiatric, too authoritarian.”

Francois Lair

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The presence of a specialist educator in the mobile team also makes it possible to go to places where caregivers do not go, such as the street or a social hotel. “We are in the ‘going towards’, it is a community psychiatry, which takes into account the place of life. We rethink the suffering of the person in his environment”, says François Lair.

The mobile team has the “luxury” to be able to “healing by doing lace” thanks to a “great freedom of action”. “We are as close as possible to the desire of the patient, to his personalityassures François Lair. By making tailor-made, we try to act differently compared to the hospital, where the medical care increases.” This also represents security for this wandering public. “I’m always bothered by giving large prescriptions to people who we don’t know if we’ll see them again. There’s also a lot of educational work that is a bit laborious.”

Support or cognitive-behavioural therapies, as well as methods to manage stress, are among the tools used by the mobile team. However, urgent situations sometimes arise, with people who, “between suffering and violence”, decompensate, become aggressive, even dangerous for society. “Compulsory Hospitalization” then becomes inevitable, emphasizes François Lair.

With his laugh, sometimes nervous, Basile fluttered during the two short hours of the radio broadcast. He was able to play one of his compositions, positive feedback, keyboard. Above all, the Samu social team found him accommodation for a week. “I will be able to redo my papers”, he assures, happy. The two nurses do not intend to let go. “We are going to give him small tracks so that he does not sink further, as well as breathing spaces like todayexplains Corinne Friscaux. He is young, he has potential, but he must not be isolated.”

The mobile team aims to bring these people in great difficulty back on a path where they can benefit from the help they need, such as seeing a psychiatrist in a medico-psychological center or any other doctor in a hospital. “Our mission is also to ensure that the person integrates back into society, and that they have the confidence to ask for help again”, concludes Antoine Courtecuisse.

However, this “audience is volatile”, often without a known address, sometimes without a means of contact. Moreover, the medical team can only suggest without imposing. Basil, for his part, has already taken note of the upcoming radio workshop in April: “I’ll be there no matter what.”

* The first name has been changed at the request of the person concerned.